Provider Demographics
NPI:1063712313
Name:CHARGO, CORY DAVID (LCSW)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:DAVID
Last Name:CHARGO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 CHESTER PL APT 4A
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3637
Mailing Address - Country:US
Mailing Address - Phone:203-300-2705
Mailing Address - Fax:888-315-1209
Practice Address - Street 1:69 CHESTER PL APT 4A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3637
Practice Address - Country:US
Practice Address - Phone:203-300-2705
Practice Address - Fax:888-315-1209
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055485001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical